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Bone Marrow Transplantation

     
     

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Bone marrow is a special soft, flexible, spongy, fatty tissue that has immature cells, called stem cells. These stem cells can develop into any of the following components of blood.

  • 1. Red Blood Cells (RBC) - that carry oxygen through your body. Red Blood Cells are also called as Erythrocytes.

  • 2. White Blood Cells (White Blood Cells) - that fight infections. White Blood Cells are also called as Leucocytes.

  • 3. Platelets - that help with blood clotting.

Why is a bone marrow Transplant needed?

If any patient has bone marrow disease then there are problems with the stem cells or how they develop. There are many types of bone marrow diseases. However the symptoms of each type of bone marrow disease may vary according to its severity. But there is a tendency that the symptoms to be similar in nature. Some of the most common symptoms are bone pain, anemia, swelling in internal organs like kidneys, spleen, liver etc. and chromosomal changes. Initially conservative treatments like medication, blood transfusion etc. is given. If all the conservative treatment options fail to give the desired result and the patient's condition deteriorates then a Bone Marrow Transplantation may be considered by the doctors.

A bone marrow transplantation (BMT) is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.

Bone marrow transplantation is used to treat various diseases that affect the bone marrow cells and some types of cancer such as multiple myeloma, lymphoma, and leukemia. A bone marrow transplant procedure may also be used to replace bone marrow that is either not working properly or has been destroyed due to chemotherapy or radiation therapy used for treating cancer.

What are the diseases treated using Bone Marrow Transplant?

A bone marrow transplant may be used to treat Non-cancerous or Non - Malignant Diseases and Malignant or Cancerous Diseases. The following are some of the conditions where doctors may consider Bone Marrow Transplantation as one of the treatment options.

Non Malignant Diseases

  • Thalassemia

  • Immunodificiency Disorders

  • Sickle Cell Disease

  • Aplastic Anemia

  • Fanconi's Anemia

Malignant Diseases

  • Acute leukemia

  • Immunodeficiency disorders

  • Multiple myeloma

  • Hodgkins lymphoma

  • Medulloblastoma

  • Neuroblastoma

  • Chronic myeloid leukemia

  • Myelodysplastic syndrome

  • Non Hodgkin's Lymphoma

  • Ewing's sarcoma

  • Mixed germ cell tumor

What are the different types of Bone Marrow Transplants?

As mentioned earlier, bone marrow transplantation (BMT) involves taking out stem cells that are normally found in the bone marrow, filter those cells, and replace unhealthy cells with these filtered healthy cells in the patient. The main aim of BMT procedure is to put healthy bone marrow cells into a patient after their unhealthy bone marrow has been removed.

Now the stem cells can come from three sources. Hence, based on the source of stem cells, there are three different types of bone marrow transplants. The following are three different types of Bone Marrow Transplants.

  • Autologous Bone Marrow Transplant : In this type of a bone marrow transplant, the source of stem cells is the patient himself. That means the patient is donor and during the procedure the stem cells are taken from the patient either by bone marrow harvest or apheresis and then given back to the patient after intensive treatment. This type of bone marrow transplant is done when the patient is undergoing high-dose chemotherapy or radiation treatments. The healthy stem cells are taken out from patient's body and stored in a freezer (cryopreservation). Once the chemotherapy or radiation treatments are done, the healthy stem cells which were preserved earlier are put back in patient's body to add to the normal blood cells.

  • Allogeneic Bone Marrow Transplant : In this type of Bone Marrow Transplant, the stem cells are taken either by bone marrow harvest or apheresis from a genetically-matched another person who is called a donor .Generally the donor has to be a HLA matched sibling or parent. It can also be an unrelated bone marrow transplant when the donor is not a relative of the patient but there has to be HLA matching between the donor and the patient. It may be sometimes very difficult to get such donor and might have to be found in national and international bone marrow registries. In such a scenario the patient might have to wait for a very long time till he/she gets a suitable donor and if the stem cells have to be got from international registries then the procedure may become more expensive.

  • Umbilical Cord Blood Transplant : In this type of bone marrow transplant the source of stem cells the umbilical cord. The stem cells from the umbilical cord are taken immediately after delivery of an infant. These stem cells are than tested, typed, counted, and frozen until they are ready to be transplanted. Hence this type of transplant can only be done on a patient who has umbilical cord stem cells preserved at the time of birth.

It has to be noted that, it is the expert team of the doctors and bone marrow specialists who decide the suitability of a type of bone marrow transplant for a particular patient. This is done after thorough testing and evaluation of the patient. In case of allogeneic bone marrow transplant the patients who get registered in the registry in order to get suitable donors might have to wait for some time. The exact duration cannot be assured since a patient may get a suitable donor within few weeks or it may even take upto a year or so.

Before the bone marrow transplantation process the following methods may be used to diagnose the type and severity of the disease.

  • A Bone marrow aspiration method, where a small amount of this tissue in liquid form is used for the examination or testing.

  • A Bone marrow biopsy which involves the removal of soft tissue known as marrow from inside the bone for examination.

  • A Bone marrow culture, where the bone marrow in certain bones is used for testing in order to find out if there is an infection inside the bone marrow.

The following are the various steps involved in a Bone Marrow Transplantation procedure.

1) Preparation

The major factor which determine if the transplant is to be carried out or not are the age of the patient, general physical condition of the patient, the diagnosis of the disease and the stage of the disease. The patient has to be healthy enough to undergo the severity of the transplant procedure. Before the transplant is done a series of tests are carried out to ensure the patient is physically capable of undergoing a transplant.

In order to find out whether the patient is fit for a bone marrow transplant, a series of tests to check the functioning of various organs like heart, lung, kidney and other vital organ functions are performed. These tests also serve as a patient baseline against which post-transplant tests can be compared in order to determine if any body functions have been impaired or not. In case of allogeneic bone marrow transplant, along with the testing of the patient, the testing of the donor is also carried out to assess donor's overall health condition, exposure to viruses, and complete genetic analysis to determine the extent of the match.

Most importantly if the donor is other than the patient himself/ herself than the donor and the recipient are matched. Matching involves typing more than hundred human leukocyte Antigen (HLA) tissues. The engraftment of donated marrow is better if more antigens are matched.

2) Bone Marrow Harvest

Bone marrow harvest is the procedure of collecting of the bone marrow from the bone. The bone marrow can be collected from the patient or a donor depending on the type of bone marrow transplant. A bone marrow harvest is carried out under general anesthesia as it may cause certain discomfort to the patient. To extract the marrow a needle is inserted into the cavity of the rear hip bone or "iliac crest" where a large quantity of bone marrow is located. It has to be noted that it is a very simple procedure and there are no stitches or surgical incisions involved. The donor need not worry since only the skin punctures are there where the needle was inserted. The amount of marrow to be harvested depends on the condition of the patient and the concentration of bone marrow cells in the donor's blood.

3) Procedure

If the patient is undergoing chemotherapy or radiation therapy then the bone transplant procedure occurs a day or two following the chemotherapy and/or radiation treatment. The bone marrow is infused into the patient intravenously i.e. in the same way in which any blood product is given to a patient. The transplant is not a surgical procedure and it does not require to be carried out in an operating room. During the procedure, when the bone marrow is being infused, the patient is continuously observed for any signs of fever, chills, hives and chest pains.

4) Engraftment

The most critical time is the 2-4 weeks period after the bone marrow transplant. This is because the high-dose chemotherapy or/and radiotherapy which was given to the patient before the transplant procedure might have destroyed the patient's bone marrow thereby crippling the body's immune system or defense system. Till the time the transplanted bone marrow migrates to the cavities of the large bones, engraft and start producing normal blood cells, the patient will be very susceptible to infection and excessive bleeding. The patient is thus kept on multiple antibiotics and blood transfusions to help prevent and fight infection. Transfusions of platelets are also done to prevent bleeding. Allogeneic patients are given additional medications to prevent and control graft-versus-host disease. Till the time complete engraftment occurs extraordinary precautions will have be taken to minimize the patient's exposure to viruses and bacteria.

Once the infused bone marrow finally engrafts and begins producing normal blood cells, the patient will slowly be taken off the antibiotics, and blood and platelet transfusions would also be stopped.

5) Recovery

The patient and the family members have to be very careful regarding the hygiene and health of the patient. Preventing Infections after Bone Marrow Transplant is the most important lookout once the patient is discharged from hospital. The new bone marrow normally takes almost a year in order to function normally. During this period the patient is to be monitored closely to identify any infections or complications that may develop. The recovery process continues for several months or longer after discharging from the hospital, during which time the patient cannot return to work or many previously enjoyed activities. As the immune system is weak after the transplant and patient is more prone to catch infection. High levels of hygiene shall be maintained at all times, which includes regular hand washing, preventing direct contact with items outside the house, prevention from any sort of respiratory or other infection.

Risks

All the types of bone marrow transplants are quite risky procedures, and the risk involved may be higher or lower depending on kind of disease, treatment, age, health status etc. Some of the risks involved in a Bone Marrow Transplant are infection, bleeding from intestines, lungs or any other body part, anemia, weakness, diarrhea, vomiting, nausea, pain, inflammation and discomfort in the mouth, throat, esophagus, and stomach, cataracts, premature menopause, graft failure, graft-versus-host disease ,children getting transplants may have deferred growth etc.

How to get started?

In India there are few world-class and completely equipped Bone Marrow Transplantation centers. Treatment Assistance has a wide network of some of the top Bone Marrow Transplant centers in India. The centers are very advanced in terms of technology and infrastructure. The clinical staff and the doctors are well experienced and trained in this filed. Now you can get a free no obligation opinion from some of the top bone marrow transplant specialists in India by sending the following details to us by email at info@mentorsethicare.com.

  • Latest medical reports of the patient

  • Age of the patient along with brief medical history

  • Donor- Patient HLA match report

For more information on high quality and low cost bone marrow transplant in India, you can write to us at info@mentorsethicare.com or call us anytime at 0091 9611 231 188

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